eNews - June 2007

The snail in my fish tank hasn’t moved in three days. It did this
once before and I almost removed it, when, inexplicably, it started
crawling and cleaning the glass. Pet shop guy says it was only sleeping
for a week. Apparently, once enough gunky stuff (read, snail food) builds
up, snails go about their business. It would seem that snails ...

A PNC Financial Services-sponsored survey of 1000 U.S. consumers
finds that nearly two-thirds want more information about costs and quality
of care while 85 percent want those costs disclosed to the public. More
than half say that those figures would influence where they seek care.
The majority of those respondents with a high deductible health plan
are far more conscious of healthcare costs due to the low premium/higher
out-of-pocket expense aspects of the plans. The challenge is that few
seem to truly understand their medical bills and the payment process.
Additionally, the survey questioned 150 hospital, health system and
insurance organization executives, with 72 percent saying that HDHPs
add yet another layer of complexity to the claims, billing and payment
process. Fully two-thirds of those executives, as well as the same percentage
of the consumers surveyed, agreed that making the claims process more
efficient would slow rising healthcare costs. Additional survey findings
revealed 33 percent of consumer respondents contacted their health plan
once in the last year to resolve a claim while 25 percent called two
or three times. Fully six in ten did not even know there is a time limit
within which to dispute a claim. The PNC e-Health Study was conducted
by the Boston-based independent research firm of Chadwick Martin Bailey
with executive survey questions asked by phone and the consumer questions
asked online.

A collaboration of more than 100 of the United States’ biggest employers
recently produced a health reform proposal. The Employee Retirement
Income Security Act Industry Committee (ERIC) proposes to create several
standardized health insurance plans for benefits administrators to offer
to both America’s insured and uninsured workers. This would effectively
result in workers shopping for their health and retirement benefits
via regional benefit administrators rather than the current employer-based
system. While ERICs proposal would give employers the choice of providing
worker health insurance via the current model or take an arms length
approach via the standardized health insurance benefits administrator
model, many consumer advocate groups see it as employers opting out
of employer-based healthcare. A key point of the proposal is the requirement
for workers to contribute to their own retirement accounts, which enables
the self-employed and unemployed to create subsidies to supplement their
incomes via coverage purchased through the administrators. The proposal
would need congressional approval for some of the elements and currently
does not provide any cost estimates.

The Federal Agency for Healthcare Research and Quality (AHRQ) has
ranked Wisconsin first in the nation in healthcare quality, with the
state’s hospitals getting the highest score nationally as well. The
state also was among the top five in ambulatory care and in the top
25 percent for nursing home care. Home healthcare was the state’s major
statistical anomaly with an overall score of just 25, while the top
performing states in that category (Michigan and Pennsylvania) pulled
scores of 95. No states did well in all areas with even Wisconsin ranking
worse than average in suicide deaths and avoidable hospitalization for
influenza. The AHRQ “State Snapshot” ranking, which is in its fourth
year, is based on 129 quality measures in four different care settings
across all 50 states. The ranking is just one more indicator of the
drive towards transparency and improved healthcare quality. “What gets
measured and reported publicly tends to get improved faster,” says Wisconsin
Collaborative for Healthcare Quality President and CEO Christopher Queram.

The Office of the National Coordinator for Health Information Technology
released the summary report of the Nationwide Health Information Network
(NHIN) Prototype Architectures recently. The new report identifies and
describes primary technical needs and services for ongoing NHIN development
and includes common elements that will be used in the next phase in
the NHIN Trial Implementations. The report also catalogs the first year’s
work on the project, during which four prototype architectures were
developed, tested and successfully demonstrated. Completion of this
work was done by collaboration of a consortia led by IBM Corp., Northrop
Grumman Corp., Accenture Ltd. and Computer Sciences Corp. The purpose
of the trial implementations is to demonstrate the critical role of
state-level and regional health information exchanges and to address
many issues central to the NHIN “network of networks.”

Seeking a firm timeline for widespread adoption of Health Information
Technology (HIT) for achieving a reduction of medical errors, AARP,
Business Roundtable and SEIU delivered a set of endorsed principles
for HIT to Congress as part of the group’s “Divided We Fail” campaign.
Together the three groups, which represent more than 50 million people
in the United States, implored Congress to help to increase safety and
efficiency in the country’s healthcare system by immediately addressing
HIT issues. The nonprofit AARP, Business Roundtable—an association of
chief executive officers of leading U.S. companies, and SEIU, the largest
healthcare union, collectively believe that HIT will be a critical building
block for large-scale reform of the American healthcare system. A study
released in 2005 from the non-profit think-tank, RAND Corporation estimated
that an average of more than $77 billion per year could be saved for
both inpatient and outpatient care if most hospitals and doctors’ offices
adopted HIT. Reduced hospital stays, reduced nurses’ administrative
time, and more efficient drug utilization would account for the largest
savings. Widespread adoption of HIT would raise the potential efficiency
savings to $165 billion annually, according to the study. The five endorsed
principles of HIT that Divided We Fail delivered to Congress are:

All Americans should have access to a secure, uniform and interoperable
healthcare system that provides administrative and confidential
medical information.

Adoption of a uniform health information system can improve
the patient experience, increase positive health outcomes and realize
significant savings.

This legislation should include grants, loans or tax credits
for providers to assist in the purchase of interoperable HIT systems.

The legislation should also ensure adoption of interoperable
systems by all payers and providers as early as possible.

To maintain momentum of the issue, Divided We Fail will be scheduling
meetings with bipartisan leaders of both chambers of Congress and the
presidential administration to discuss the need for HIT legislation
in the weeks to come.

Click here
for more information on the Divided We Fail lobbying campaign.

Companion Data Services (CDS), IT services provider to the Centers
for Medicare & Medicaid Services (CMS), has launched data center operations
to support Medicare claims processing under Medicare’s Enterprise Data
Center Initiative. The initiative is the driving force behind a series
of reforms aimed at modernizing and improving the efficiency for claims
processing. CDS Columbia data center has already transitioned successfully
the first Enterprise Data Center workloads and is currently hosting
applications being used in six states around the country with work already
underway in 17 more states. CMS is consolidating its data center operations
at more than 20 facilities into four high-tech enterprise data centers.
CMS awarded a 10-year contract in 2006 to CDS, EDS and IBM to operate
the new data centers. The contract award also qualifies these companies
to compete for task orders that have a combined value of $1.9 billion.
Medicare expects these new data centers to accommodate their growing
volume of claims, standardize operations and expanded electronic services,
as well as bolster security and lower costs by millions of dollars over
the next 10 years. CDS has already been awarded two task orders with
a combined value of more than $228 million from CMS. To support the
project, CDS has expanded the staffs at its Columbia, South Carolina
and Dallas offices. In further support of the new project and their
partnership with CMS, CDS also has opened a field office in Baltimore.
By September, 2008, CMS plans to transfer operations for all fee-for-service
Medicare claims to the Enterprise Data Centers in staggered workloads.
At which point, CDS will support the processing of approximately 650
million claims submitted annually by hospitals, physicians and other
providers across 30 states, Washington D.C. and Puerto Rico. Currently,
CDS represents about 54 percent of the nation’s fee-for-service claims.